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AMANDA's TWO FRIENDS - Coggle Diagram

- - - - holds the tooth firmly in place in the socket. In periodontitis patient,bacteria affected the periodontal ligament that anchor the tooth thus high chances of tooth loss.
    - - Relate to people psychological thinking on how they feel, how they look ,how they speak
        Good periodontal health boost their confidence
    - - -if not treat the calculus build up , complicated with periodontitis, thus arise other problems such as tooth loss
  - - - The term early-onset periodontitis was too restrictive and recommended it be replaced with Aggressive Periodontitis
      - Diagnosis of aggressive periodontitis is made on clinical, radiographic and historical findings which show rapid attachment loss and bone destruction, and possible familial aggregation of disease.
      - Except for periodontal disease, patients are systemically healthy
  - - - Able to obtain proper history and diagnosis
      - Able to understand patient’s expectation and value
      - Show respect, concern and consideration to the patient
      - Reduce dissatisfaction and unmet expectation
      - Able to encourage patient to participate in healthy decision making or choices
    - - To reduce fear and anxiety
      - To ensure patient feel safe, respected and comfortable
      - To encourage patient participation in decision making or treatment plan
      - Has given enough information to make informed choice
      - To increase patient compliance and trust
      - Has the ability to ask and discuss about their concern
- - - - -Periodontal charting is one of the most important steps in periodontal management.
        -It is a measurement of how deep the pathogenic bacteria have resided in periodontal tissue.
        -Result of measurement will be the guide to remove the pathogenic bacteria appropriately.
        -It is to enable the dentist to detect early signs of periodontal problems.
  - - - As a general guide, radiograph may be needed for periodontal assessment for BPE codes 3, 4, *
        To assess the degree of bone loss eg. ⅓, ½, ⅔ of the root length or percentage.
        To assess pattern of bone loss eg. vertical bone loss or horizontal bone loss.
        To identify any subgingival calculus and defective restoration.
        To assess the root length, root resorption and morphology of root and remaining bone support of periodontally involved teeth.
        To detect furcation involvement of molar teeth.
        For a general view of periodontal ligament space and periapical region.
        For screening for orthodontics treatment and assess problems in teeth alignment (lateral ceph)
- - - - Tooth decay from the glue used
      - Tooth mobility
      - Soft tissue injury
      - Choking hazard (braces may unwind and end up in your throat while sleeping, causing choking)
      - Poisoning from toxic materials (like cheap rubber) and unstrelizied materials
      - Foul breath
      - Unwanted tooth movement (you could end up with more crooked teeth)
  - - - FACTORS AFFECTING TREATMENT IN MULTIDISCIPLINARY MANAGEMENT
        
        Considerations, indications and contraindications for combined treatment.
        
        Benefits and risks.
        
        Orthodontic regimens and appliances, its effects of periodontal health.
        
        Consideration of surgical technique and procedures associated with positive outcomes from combined therapy.
- - - - Healthy Periodontium
        
        Resorption occurs where there is pressure and new bone forms where there is tension
        
        This “frontal resorption” occurs when light forces are applied.
        
        When Excessive pressure is applied to a tooth: periodontal ligament is compressed, until the blood supply is cut off from the periodontal ligament.
        
        creates an avascular cell-free zone called “hyalinization” and tooth movement then stops temporarily.
        
        the adjacent alveolar bone undergoes “undermining resorption”.
        
        Frontal resorption of bone is more desirable than undermining resorption,
        
        less discomfort and is least harmful to the periodontium.
      - Diseased Periodontium
        
        The periodontal ligament does not regenerate when there is inflammation in the periodontal tissues.
        
        When teeth are moved orthodontically, in the presence of plaque
        
        bone and attachment loss
        
        higher loss of bone density
        
        Orthodontic components which are attached to the tooth surface may also hinder effective cleaning of teeth
        
        Those patients who have a pre-existing periodontal disease have a higher risk of their periodontal health deteriorating further if plaque control is inadequate.
        
        The periodontal problems needs to be controlled first before, during and after the entire orthodontic treatment.
    - - Long treatment duration
      - Increased amount of tooth movement
      - High force magnitude and over longer duration
      - Extractions of teeth and large spaces to close during treatment
      - Poorly controlled or active periodontal disease,
      - Inadequate/ineffective cleaning of teeth
    - - improved healing of infrabony defect when good oral hygiene measures were implemented
        (Studies reported)
      - In the trigger, states that Amanda's teeth were bonded with fixed appliance after a year treatment of scaling and root planning every 3 months, also surgical treatment was done concurrently with the orthodontic treatment
      - Effects Of Orthodontic Treatment On Periodontal Tissues In Patients With Reduced Periodontal Support by Eliasson (1982): Pre-orthodontic treatment + low forces = no increased progression of marginal periodontitis due to orthodontic tooth movement.
        
        Oral Hygiene Treatment
        
        Scaling, extractions, compliance review
        
        Orthodontic Treatment
        
        4-6 months after
        
        Incisors retracted using elastics on the labial with 40g force
        
        Post-Orthodontic Treatment
        
        Ortho movement stabilised
        
        Periodontal surgery in remaining pathological pockets after a few months
      - Effects
        
        When orthodontic forces are applied to teeth, both compressive and tensile stresses develop in surrounding tissues
        
        Orthodontic treatment can aggravate periodontal issues especially in infrabony defect
        
        Increase risk of gingivitis by increase amount of acidogenic biofilm
  - - - To alter/eliminate the microbial etiology that contribute to periodontal diseases.
      - Effective daily plaque removal at home by every patient.
    - - Increase access to the root surface
      - Reduce or eliminate deep pocket depths
      - Reshape soft or hard tissues to achieve harmonious topography
    - - Focuses on restoration of the defects with fixed or removable prosthodontics, Periodontal Prosthesis, or other kinds of restorations are done.
    - - In the maintenance phase, patients are placed on a schedule of periodic recall visits for maintenance care to prevent recurrence of the disease.
    - - PERIODONTAL REGENERATION -
        
        Guided Bone Regeneration
        
        Guided Tissue Regeneration
      - MUCOGINGIVAL THERAPY
        
        Free gingival graft
        
        Connective tissue graft,
        
        Pedicle grafts